Irs Form 941 2012

Cat. No. 17001Z Form 941 Rev. 1-2012 Part 2 Tell us about your deposit schedule and tax liability for this quarter. 941 for 2012 Form Rev. January 2012 950112 Employer s QUARTERLY Federal Tax Return OMB No. 1545-0029 Department of the Treasury Internal Revenue Service Employer identification number Report for this Quarter of 2012 EIN Check one. Name not your trade name 1 January February March 2 April May June Trade name if any 3 July August September Address Number Street 4 October November December Suite or room number City State Prior-year forms are available at www.irs.gov/form941. Name not your trade name 1 January February March 2 April May June Trade name if any 3 July August September Address Number Street 4 October November December Suite or room number City State Prior-year forms are available at www*irs*gov/form941. ZIP code Read the separate instructions before you complete Form 941. Type or print within the boxes. Part 1 Answer these questions for this quarter. Number of employees who received wages tips or other compensation for the pay period including Mar* 12 Quarter 1 June 12 Quarter 2 Sept. 12 Quarter 3 or Dec* 12 Quarter 4 Wages tips and other compensation Income tax withheld from wages tips and other compensation If no wages tips and other compensation are subject to social security or Medicare tax. Column 1 5a Taxable social security wages. 5b 5c Taxable Medicare wages tips. 5d Add Column 2 line 5a Column 2 line 5b and Column 2 line 5c 5e Section 3121 q Notice and Demand Tax due on unreported tips see instructions Total taxes before adjustments add lines 3 5d and 5e. Current quarter s adjustment for fractions of cents. Check and go to line 6. Total taxes after adjustments. Combine lines 6 through 9 Total deposits for this quarter including overpayment applied from a prior quarter and overpayment applied from Form 941-X or Form 944-X. 12a COBRA premium assistance payments see instructions 12b Number of individuals provided COBRA premium assistance. Add lines 11 and 12a. Balance due. If line 10 is more than line 13 enter the difference and see instructions Overpayment. If line 13 is more than line 10 enter the difference Apply to next return* Next You MUST complete both pages of Form 941 and SIGN it. For Privacy Act and Paperwork Reduction Act Notice see the back of the Payment Voucher. Send a refund. If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor see Pub. 15 Circular E section 11. Line 10 on this return is less than 2 500 or line 10 on the return for the prior quarter was less than 2 500 and you did not incur a 100 000 next-day deposit obligation during the current quarter. If line 10 for the prior quarter was less than 2 500 but line 10 on this return is 100 000 or more you must provide a record of your federal tax liability. If you are a monthly schedule depositor complete the deposit schedule below if you are a semiweekly schedule depositor attach Schedule B Form 941.